7.
Why? <ul><li>Coupled with pain, the inflammatory response limits the use of the injured structure </li></ul><ul><li>Avoiding the possibility of further injury to the affected tissue. </li></ul>

8.
Medications <ul><li>Considerations </li></ul><ul><ul><li>Compliance </li></ul></ul><ul><ul><ul><li>59% in TID medications </li></ul></ul></ul><ul><ul><ul><li>84% in Once a day medications </li></ul></ul></ul>

13.
Pain Ladder <ul><li>The administration of medications to control pain consists of scheduled, ‘by the clock’ rather than ‘as needed’ or ‘on demand’ doses. </li></ul><ul><li>Considered to be relatively inexpensive and 80 to 90% effective </li></ul>

14.
Non-steroidal Anti-inflammatories (NSAIDs) <ul><li>~30 million people take NSAIDs daily </li></ul><ul><li>20 million of prescriptions in the UK yearly </li></ul><ul><li>May contribute to 2,600 deaths annually </li></ul><ul><li>Anti-inflammatory, antipyretic and analgesic effects </li></ul>

17.
Acetaminophen <ul><li>N-acetyl-P-aminophenol (APAP) </li></ul><ul><li>No anti-inflammatory effects </li></ul><ul><li>First line of treatment </li></ul><ul><ul><li>Patients allergic to aspirin or NSAIDS </li></ul></ul><ul><ul><li>Inflammation is not a predominant component of the pain complex </li></ul></ul>

20.
Opiates <ul><li>Gold standard for pain control. </li></ul><ul><li>High potency and risk of physical dependence </li></ul><ul><li>Potential for abuse </li></ul><ul><ul><li>Should be limited to moderate to severe pain levels </li></ul></ul><ul><ul><li>Used for short periods of time </li></ul></ul>

21.
Opiates <ul><li>If a patient requires opiates for more than 3-4 weeks, long acting opiates for pain control should be considered. </li></ul><ul><li>Short acting opiates for chronic pain control </li></ul><ul><li>Inferior for continuous pain control </li></ul><ul><li>Promote “pain behavior” </li></ul>

23.
Compounded agents <ul><li>Second step agents in the “pain ladder” are available in combination with APAP or NSAIDs </li></ul><ul><li>Often over the counter cold remedies contain APAP </li></ul><ul><li>High risk for surpassing the ceiling level. </li></ul>

24.
Tramadol <ul><li>Central analgesic with binary action </li></ul><ul><ul><li>Weak opioid mu receptor agonist </li></ul></ul><ul><ul><li>Reuptake inhibitor of norepinephrine and serotonin. </li></ul></ul><ul><li>Indicated for moderate to severe pain. </li></ul><ul><li>It is considered to be more appropriate than NSAIDS for patients with gastrointestinal or renal disease. </li></ul>